Endometrial cancer is currently the most frequent malignancy of the female lower genital tract in developed countries. Stratification of tumor extension is based on surgical findings and pathological examination of the resected specimen. Routine treatment is carried out through a standard laparotomy, although some studies have suggested that the operation can be performed by laparoscopic-vaginal approach with the same level of oncological radicality and without increasing the rate of complications.The purpose of this study was to assess the feasibility of laparoscopy in the surgical treatment of clinical stage I endometrical carcinoma and to compare and the results obtained with those of laparotomy. The primary objective of the study was the comparison between both procedures in terms of overall survival, disease-free survival, and rate of complications. Secondary objectives included a comparison of surgical data, retrieved retroperitoneal lymph nodes, and length of hospital stay.Surgical stratification in both procedures included peritoneal cytology, extrafascial hysterectomy with bilateral salpingoophorectomy, bilateral pelvic lymphadenectomy ± para-aortic lymphadenectomy and omentectomy, and random biopsies in high-risk histological types. Most data were recorded prospectively. All patients with a diagnosis of primary endometrical carcinoma, stage I, attended at the Hospital Materno-infantil Vall d'Hebron in whom surgery was indicated as the primary treatment modality were included. The SPSS, version 11.0, software computer progarm was used for the analysis of data. Tests of normality, non-parametric tests, the Kaplan-Meier test for the analysis of overall survival and disease-free survival with the long-rank test for the comparison of survival curves, and a Cox proportional regression analysis were used.Between January 1995 and June 2001, a total of 371 patients with clinical stage I endometrial cancer were included. Stratification of the disease was made by the laparoscopic-vaginal approach in 55 patients (14.88%) and by laparotomy in 315 (84.9%). The mean age of the patients was 64.3 years and the body mass index 30 kg/m2 (range 18-57). Optimal stratification surgery was achieved in 367 patients (98.9%), without significant differences between both surgical routes. A total of 91.1% of patients underwent pelvic lymphadenectomy and 50% para-aortic lymphadenectomy. Positive lymph nodes were found in 41 cases (11.1%) and a total of 32 relapses (8.6%) were documented at follow-up. Edometrioid carcinoma was the most frequent (74%) histological type followed by the high-risk group (serous papillary, clear cell, and adenosquamous) (16%). In 27.3% of cases, the tumor was poorly differentiated (G3). Distribution of cases according to FIGO stage included stage I in 58% of cases, stage II in 24%, stage III in 16%, and stage IV in 2%. After a mean follow-up of 40.7 months, the overall survival rate was 92.2% (mean survival 93 months), with 90% for the laparotomy group and 100% for the laposcopic group. Differences in survival between both groups were not statistically significant (P=0.06). Disease-free survival for all patients was 91.4% (mean 93.2 months), with 92% for the laparotomy approach and 98.2% for the laparoscopic group. Differences in disease-free survival between both procedures were not statistically significant (P=0.09).However, there were significant differences (P<0.001) between both surgical routes with regard to operative data: mean blood loss, number of blood transfusions required, and mean length of hospital stay, which were lower in the laparoscopic group. In contrast, the mean surgical time was significantly longer in this group. The mean number of pelvic and aortic nodes recovered was higher in the laparoscopic group (P<0.001). The number of complications was similar for both routes (P=0.26). In patients undergoing surgery through the laparoscopic approach, no case of conversion to laparotomy was necessary.The two study populations were similar in baseline characteristics and histopathological variables. In the multivariate analysis and after adjusting for different clinical and morphological parameters, independent variables significantly associated with survival were poorly differentiated histological grade, age, and stage IVa, whereas independent predictors of disease-free survival were high-risk histological type, age, and stage IVa.It is concluded that surgical stratification of endometrial cancer by means of laparoscopic-vaginal approach is feasible and safe, with lower morbidity and shorter length of hospital stay. However, these results should be confirmed in the framework of a clinical trial.